Human Trafficking Victim Identification and Response Within the United States Healthcare System


Health Burdens

Trafficking is associated with significant health burdens for victims (Ottisova, 2016; Ottisova, 2018; Kiss, 2015). Human trafficking victims have an increased risk for physical injuries such as fractures, lacerations, chronic pain, headaches, skin conditions, malnutrition, infectious diseases, reproductive health problems, dental problems, and persistent mental health problems such as post-traumatic stress disorders, depression, anxiety, and suicidality (Oram, 2012: Ottisova, 2016; Ottisova, 2018; Kiss, 2015; WHO, 2012). Substance use and abuse is prevalent among victims of human trafficking. Substance use is a risk factor for being trafficked, is used as a way to control victims, and is used as a means of coping with physical and psychological abuse both during and after trafficking (Goldberg, 2017; Goldberg, 2018; Salami, 2018; Le, 2018). One study of 107 survivors of human trafficking reported that 84.3% of those trafficked used alcohol or drugs while a victim and nearly one-third of victims were forced to use alcohol or drugs as a control mechanism (Lederer, 2014). Given the increased risk of health problems related to trafficking, victims often encounter the healthcare system through primary care, emergency departments, and community health clinics.

Interaction with the Healthcare System

Staff working in nursing homes and geriatric care units report frequent verbal and physical assaults, likely due to the confusion, agitation, and aggression caused by age-related cognitive decline. A cross-sectional study of 539 nursing home assistants found that 66% of respondents report experiencing daily physical assault resulting in minor soreness, abrasions, scratches, or bruises. Elderly patients are a uniquely vulnerable population, and nuanced solutions are required to address the high rates of violence in long-term healthcare settings.

2.4 Intensive Care Units

While many studies show that over 80% of victims have interacted with the healthcare system while being trafficked, these victims often go unnoticed (Baldwin, 2011; Chisolm-Straker, 2016; Chisolm-Straker, 2018; Ijadi-Maghsoodi, 2018; Ravi, 2017). In one survey, almost a third of victims indicated they came in contact with healthcare providers while being trafficked but were not recognized as being victims (Family Violence Prevention Fund, 2005). Another survey indicated that 85% of trafficking victims had received treatment for an illness or injury directly related to their work or exploitation (Polaris, 2020). Evidence shows that most victims (63%) receive care through emergency departments (Lederer,2014). The healthcare setting may be the first nonfamily point of contact for victims of abuse. Despite these opportunities to assist human trafficking victims, surveys of healthcare professionals indicate that only 6 percent of providers reported ever treating a human trafficking victim and the majority (57%) of victims of trafficking report never being asked trafficking or abuse-related questions during their healthcare visits (Polaris, 2018).

There are, however, clear signs that the healthcare industry is taking human trafficking seriously. More than 14 medical societies including the American Hospital Association have created policies on human trafficking, and many states have mandated training and education for healthcare providers. Another major step in understanding human trafficking and how healthcare can respond to this crisis is the creation of new disease classification codes to recognize and classify human trafficking victims and to differentiate human trafficking victims from other abuse victims. The first trafficking-specific codes were approved for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These codes are expected to strengthen data collection on the incidence and risk factors for trafficking, the burden of comorbid illness and injury, and the resources needed to effectively care for trafficked persons. The 2019 Addenda for the ICD-10-CM List of Diseases and Injuries are in Table 1.

Table 1: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for Human Trafficking

Under Adult and child abuse, neglect and other maltreatment, confirmed T74.5 – Forced sexual exploitation, confirmed
T74.51 – Adult forced sexual exploitation, confirmed
T74.52 – Child sexual exploitation, confirmed
T74.6 – Forced labor exploitation, confirmed
T74.61 – Adult forced labor exploitation, confirmed
T74.62 – Child forced labor exploitation, confirmed
Under Adult and child abuse, neglect and other maltreatment, suspected T76.5 – Forced sexual exploitation, suspected
T76.51 – Adult forced sexual exploitation, suspected
T76.52 – Child sexual exploitation, suspected
T76.6 – Forced labor exploitation, suspected
T76.61 – Adult forced labor exploitation, suspected
T76.62 – Child forced labor exploitation, suspected
Under Encounter for examination and observation for other reasons Z04.81 – Encounter for examination and observation of victim following forced sexual exploitation
Z04.82 – Encounter for examination and observation of victim following forced labor exploitation
Under Problems related to upbringing: Personal history of abuse in childhood Z62.813 – Personal history of forced labor or sexual exploitation in childhood
Under Personal risk factors, not elsewhere classified: Personal history of psychological trauma, not elsewhere classified Z91.42 – Personal history of forced labor or sexual exploitation